Friday, 28 November 2014

Childhood illness in twentieth-century Ireland by Ida Milne

In this month's blog post, Dr Ida Milne,  Irish Research Council ELEVATE fellow co-funded by Marie Curie Actions, writes about her postdoctoral project on childhood illness in twentieth-century Ireland.

We live in an era where we expect our children to survive to adulthood without having their lives threatened by common infectious diseases of childhood.  The situation was rather different in the Ireland of the early part of the twentieth century. In 1911, more than 2,000 infants under the age of two died from diarrhoeal illnesses, almost double the number that died the previous year.  The increase was not helped by the hot summer, which exacerbated the hygiene difficulties in an era when many houses, even of the affluent, did not have running water or flush toilets. As a twenty first century mother, I find the idea of nursing a child suffering from diarrhoea in an overcrowded third floor  bathroomless tenement almost unimaginable. 

Child mortality in the early-twentieth century

Having healthy children who would survive to adulthood was not taken as the norm, as we do now. Statistics tabulated by the Registrar-General in 1911 show that one-fifth of the total 72,475 deaths in 1911 were children under 5; of these, 945 were caused by ‘convulsions’ and 1,370 by bronchitis. Scarlet fever claimed the lives of 260 children under fifteen; 460 under-fifteens died from measles, and 819 under tens from whooping cough.  

Slums in Dublin, c.1865-1914 (Image from NLI collection: L_ROY_07881)

Dublin tenements, poverty, and childhood illness

Few families, rich or poor, remained untouched by these deaths, but the over-crowded living conditions of the poor could bring extremes of ill health. Stella Larkin McConnon, trade unionist James Larkin’s granddaughter, told me that the poor health of the nation’s children was one reason he became so interested in improving living conditions for families.  The Larkins had good reason to be aware of the suffering.  Stella’s own mother was brought up in Marlborough Street in the heart of Dublin’s tenements, and was the only one of ten children to survive to adulthood.  Stella still remembers visiting the tenement, one room with only one metal bed, the only toilet downstairs in another part of the tenement, the cooking done on an open fire.

Improving child health

By 1981, the landscape of death in childhood had changed radically. There were no deaths in either Northern Ireland or the Republic from scarlet fever or whooping cough, and only two from measles.  Only 2.78 per cent of the total deaths, 916 of 32,929, were of children under five.

Many factors contributed to the improvements over the course of the twentieth century:  among them vaccination schemes and more effective medicines, public health education and increased state intervention in the health of children, better housing and diet and improved air quality. It didn’t happen by accident – throughout the century, there were individuals who identified areas to change and worked to effect that change.  Their number includes the first chief medical officer for Dublin, Sir Charles Cameron, trade unionists like James Larkin who worked to give families a decent wage, pioneering TB Dr Dorothy Stopford Price,  Department of Local Government and Public Health Chief Medical Officer James Deeny, Noel Browne and many others who played macro and micro roles in the significant reduction in deaths from disease in childhood.

Research project on childhood disease

In October, I began a three year  Irish ResearchElevate Fellowship in the National University of Ireland and Queen’s University, Belfast to research this dramatic changing landscape of childhood disease, which is in general a good news story for Irish society and Irish public health.  While statistical and documentary sources will be important to the project, a key feature will be a series of qualitative interviews with medical professionals, with people who worked in relevant Government and local authority roles, and with parents and sufferers. I intend that these interviews should, at the conclusion of the project, be available in an open access archive to other researchers. 

Mother (to District Visitor): "Lumme, miss! There ain't no danger
of infection. Them children wet's got the measles is at the 'ead of 
the bed, and them wet ain't is at the foot.
London Mail, 23 October 1913
Image courtesy of the Wellcome Library
The project builds on and was partly inspired by the RAMI Living Medical History project; Susan Mullaney, Mary O’Doherty and  Patrick Plunkett of the RAMI section on history of medicine devised this innovative project to interview retired medical doctors about their working lives, collecting memories on the changes in medical practice over the course of their careers. Several of the LMH interviewees had either suffered from diseases like diphtheria and tuberculosis themselves, or had family who did, and this really brought home to me how all-pervasive the effects of childhood disease were on Irish society, that they were not merely confined to the poor and the badly-housed, but could also invade better-off families.

Oral history of medical practitioners

Oral history interviews can add flesh to the dry bones of statistics. When working on my PhD on the effects of the 1918-19 influenza pandemic here,  the people who spoke to me about suffering this influenza as small children, or who told me about how their families coped with the tragic losses of children or parents to the 1918-19 flu, breathed life into its history, recreating the fear caused by the unpredictability of  this most awesome of influenza pandemics.

In the case of this new project, I am hoping to find people who can talk about the changing landscape of childhood illness in the twentieth century, from their own perspective, whether as medical workers, patients, parents or as Department of Health officials and politicians.

I’m curious about issues like knowledge transfer – how and what did parents learn about treating the illnesses their children caught?  As a child growing up in the 1960s, I recall my mother hanging blankets over the windows when we caught measles; the information she had been passed down by her mother was that children with measles could damage their eyesight if they read or were in daylight.

When I had my own children in the 1990s, I was struck by the efficiency and dedication of a district nurse in north Kildare who made sure we parents brought our children for vaccinations, and cajoled and informed those parents who had reservations about allowing their children to be vaccinated. Getting medical workers like her to talk about their work is one of the goals of this project. This district nurse was, it seems to me, a local hero, a micro role player who was a small but significant cog in the expanding machinery which managed and significantly improved the health of our children over the course of the twentieth century. 

Dr Ida Milne is a social historian based at NUI Maynooth and Queen's University Belfast. She holds an ELEVATE Irish Research Council International Career Development Fellowship co-funded by Marie Curie Actions. 

Tuesday, 4 November 2014

Workshop report: Soviet healthcare in the comparative perspective by Susan Grant

In this month's blog post, Susan Grant reports on the recent 'Soviet healthcare in the comparative perspective' workshop which took place at UCD in May 2014.

Historians of Soviet and medical history met in the UCD Humanities Institute May 29-30 to discuss Soviet healthcare in comparative perspective. Generously supported by the Wellcome Trust, UCD Seed Funding, and the Irish Research Council, this workshop represented an important international gathering of scholars from Ireland, the UK, Canada, and the United States.  The inter-disciplinary nature of the workshop meant that there was much debate and discussion among participants (the programme is available on the CHOMI website here).

Nursing in the Soviet Union

The overall aim of the workshop was to analyse the history of Soviet nursing and healthcare in comparative perspective, and to critically examine issues such as professionalization, gender, and care. The workshop mandate was to evaluate Soviet nursing relative to international nursing and healthcare, and to explore how nursing in the Soviet Union developed in relation to other medical professions. Participants were asked to consider the development of Russian healthcare and to compare the Soviet healthcare system to that of other countries.

Comparative aspects of Soviet healthcare

The workshop was a great success, particularly in facilitating cross-disciplinary discussion about the comparative aspects of Soviet healthcare. Panels focused on three key aspects of Soviet healthcare: professionalization, gender and care. The issue of care and the idea of the ‘virtue script’ (as conceptualised and explained in the work of Prof. Sioban Nelson, University of Toronto) fostered a particularly engaging dialogue about how nursing care is conceived and understood. This fed into discussions of what constitutes a ‘good’ and ‘bad’ nurse, as well as patient perceptions of ‘good’ and ‘bad’ nurses.  Nursing care, whether in the Soviet Union or elsewhere, depends on a variety of factors and an individual’s experience of nursing care. Studies of Soviet nursing are limited and probing expectations of care from an international perspective proved very productive in thinking about approaches to Soviet nursing and healthcare practices.

Panel on gender

Papers that focused on gender were particularly helpful in illuminating the difficulties and challenges of dealing with source material such as memoirs, interviews, etc. Prof. Dan Healey, Dr Laura Kelly, and Prof. Christopher Burton shared their experiences of working with memoir literature and the problems this can raise in terms of medical history. This was very informative for everyone, and especially instructive in highlighting the similar experiences of scholars who focus on different periods and countries. Indeed, scholars of medical and nursing history, and also the history of Russia, Ireland, Great Britain, etc., found that they had much in common. Participants specialising in Soviet history were surprised to learn of the liberal aspects of medicine in Ireland at the turn of the century. Cross-disciplinary dialogue here proved fruitful and underlined points of intersection and diversion between Russia and the West.

Transnational healthcare

The comparative dimensions of international healthcare were underscored in the panel featuring Prof. Susan Solomon, Prof. Paul Weindling, and Prof. Anne Marie Rafferty. Papers here focused on the transnational aspects of healthcare, dealing with Soviet cultural diplomacy in the 1920s, continental nurses in the UK  1933-1945, and nursing and decolonization during the second colonial occupation of Malaya, 1946-1955.

Round table on professionalization

The issue of professionalization was discussed in the opening and round table discussions. Scholars of Russian history, including Prof. Donald Filtzer, Prof. Benjamin Zajicek, and Dr Susan Grant presented their papers on professionalisation and practice in Soviet healthcare history.  Discussions about professionalization were elaborated on in the roundtable session, with participants Prof. Susan Solomon, Prof. Sioban Nelson, Prof. Dan Healey, and Prof. Anne Marie Rafferty contributing to a lively debate. It was questioned whether or not theories of professionalisation and histories of the professions are helpful as methods in analyzing both healthcare history and the Soviet case. Findings here were inconclusive, with some scholars acknowledging the merits of professionalisation literature in their work on the Soviet Union or healthcare, and others noting that they found this literature less useful.

The workshop proved that healthcare history continues to be a vibrant field and one that has much value when considering comparative international experiences. We look forward to more discussion of these debates in the future.

Monday, 29 September 2014

Cows, contagion and sanitation and Victorian Dublin by Juliana Adelman

We are back after the summer break! In this month's post, Dr Juliana Adelman writes about her research on the history of animals and public health in nineteenth-century Dublin.

When I began working on the history of animals I was not sure where I would end up.  I was initially interested from the perspective of a historian of science with a focus on the history of natural history. However, it quickly became clear that I was much more interested in  animal-human interactions outside of the laboratory and museum.  Looking at how animals affected and were affected by changes to ideas about health and disease has allowed me to reconnect with my undergraduate experience in a microbiology lab from a totally different angle. 

Medical progress?

Looking at medicine and disease through animals really highlights how social and contingent that knowledge is.  When we look at the history of disease in humans and how society has sought to address it, we can find it difficult to get away from the idea that things are moving forward.  There is no question that human life expectancy is longer, for example, than it was in the past.  We rarely protest against the idea that states have some obligation to the health of their citizens.  Most of us go to a doctor when we feel really sick and expect that they will help us.  While the social history of medicine has made it clear that the system of medicine we have now was in no way inevitable, most of us have fully absorbed the social attitudes that it represents.  

Disease and animal-human relationships

Cattle Market, Dublin (view from North Circular Road towards Prussia St)
Image courtesy of National Library of Ireland: Lawrence Photograph Collection
When we look at disease from the perspective of animal-human relationships, however, we are forced to face the ways that our feelings and attitudes about animals have affected and been affected by the course of medicine.  For example, in our age of swine flu and avian flu and BSE we can hardly conceive of not believing diseases to pass between humans and other animals.  Yet, as Anne Hardy has pointed out and Abigail Woods's current project seeks to address, there has been no successful attempt to unite human and animal medicine as a single discipline.  There have been few attempts to address animal disease with practices other than containment by slaughter.  We have pushed animals to the margins of developed society, far away from cities and centres of population, but the ways that we depend on them continue to be highlighted in one food contamination story after another.  

The erasure of animals

So I guess what interests me is how did we get here?  To this place where urban residents depend for subsistence on animals, fear infections spread from animals, yet see themselves as completely separate from the animal world.  You need only look around Dublin to see how thoroughly we have erased their former presence: the site of the former cattle market and city abattoir now contain social housing, the North Circular Road never sees cattle blocking traffic, the Great Western railway terminus (where cattle from the country once arrived in droves) is a bus terminus.  I do not advocate the return of cows to urban Dublin, just a bit more consciousness of their role in our history.


Podcast of a lecture 'Cows, contagion and sanitation in Victorian Dublin' by Dr. Juliana Adelman, given at the Centre for the History of  Medicine in Ireland (CHOMI, UCD) Seminar Series, 26 September 2013.

Juliana Adelman is lecturer in History at St. Patrick's College, Drumcondra. To listen to a podcast of a recent paper given by Juliana at the CHOMI Seminar Series, click here and for details of the forthcoming 'Science in the City' event she is organising, click here. Juliana may be contacted at juliana "dot" adelman "at" spd "dot" dcu "dot" ie. 

Wednesday, 25 June 2014

A Malady of Migration: theatre production in Coventry and Dublin

At a time when the issues of migration and mental health are seldom out of the news, the Centre for the History of Medicine in Ireland (CHOMI) has worked with the Centre for the History of Medicine at the University of Warwick (CHM) and Talking Birds theatre company to develop a new theatre production which explores why the mid-nineteenth century saw a prevalence of mental disorders among Irish migrants.The new piece is called 'A Malady of Migration' and is based on research being carried out by Professor Hilary Marland of Warwick and Dr Catherine Cox of University College Dublin, in a project called Madness, Migration and the Irish in Lancashire, c.1850-1921, funded by the Wellcome Trust. They are supported by postgraduate students and others, who will conduct supplementary research and take supporting roles in the drama.

There will be an expert panel discussion after the Thursday evening performances in each venue and a post performance discussion on Saturday lunchtime, providing opportunities for audience members to discuss the making of the piece with researchers and the theatre company, and to engage in debate on issues raised by the performances. A series of short briefing sheets have been produced to complement the drama and provide background information. These can be accessed here.

Check out the Malady of Migration website here!


Shop Front Theatre, City Arcade, Coventry CV1 3HW (opposite Argos):
Thurs 26th to Sat 28th June 2014
1pm - £6 (£3) and 7pm - £8 (£4)
Box office 0845 680 1926

The New Theatre, Temple Bar, Dublin:
Thurs 3rd to Sat 5th July 2014
1pm - €8 (€4) and 7.30pm - €10 (€5)
Box office 01 670 3361

A Malady of Migration

Madness, migration, and the Irish in Lancashire, 1850-1921

Thursday, 12 June 2014

‘[S]he is in a highly hysterical state. She’s a woman who resists’: the Dangers of Spiritualism in J. S. Le Fanu’s All in the Dark (1866) by Valeria Cavalli

In this month's post, Dr Valeria Cavalli examines the  theme of spiritualism in Irish writer Joseph Sheridan Le Fanu's novel All in the Dark (1866), and what the author's warnings about the dangers of spiritualism tell us about Victorian attitudes to women and madness. 

The dangerous habit of practising séances

When William Maubray is called to his dear aunt Dinah’s deathbed, he hopes that he will get there in time to say goodbye. He is certainly surprised, then, to find her in quite good shape, if not for her firm conviction that she is going to die before midnight. Dr. Drake explains to the puzzled young man that his aunt suffers from nothing more serious than the ailments of a woman of her age, but that she has recently fallen victim of self-deception. The eccentric old woman has in fact taken up the dangerous habit of practising séances, and the risk is that she will drive herself mad if she insists in taking seriously the ominous revelations of her spirit friend. Written in the peak years of Spiritualism, Joseph Sheridan Le Fanu’s All in the Dark brings forth a way more terrifying reality than being haunted by ghosts, that is, being locked away in a lunatic asylum on the basis of one’s unorthodox creed.

The rise of spiritualism

Emerging in America in the late 1840s, Spiritualism spread almost immediately to Europe, finding fertile terrain in the state of religious uncertainty which was troubling part of the population, regardless of class, age, or gender. When scientific discoveries brought the credibility of the Bible into question, believers began to feel uneasy with the way Christianity explained the supernatural, and began to look for comfort in the occult. In fact, the occult could account for the supernatural according to the laws of nature: whatever forces were inexplicably ruling the Universe or man, they were completely natural, and their present state, if still unknown to science, was open to investigation. However, scientists and members of the Church together raised their voices in opposition to the movement from its very first appearance, and criticism poured from the pages of periodicals and newspapers.

Joseph Sheridan Le Fanu

Spiritualism and female transgression

As Alex Owen has pointed out in her Darkened Room (1989), many medical men regarded the movement with distaste and suspicion in part because of the increasing role it offered to women. In those years, the ideal woman was the submissive wife and mother, “the angel in the house” in charge of the domestic sphere. In giving women the authority and the right to exercise their innate spiritual powers, Spiritualism infringed on the culturally imposed limits of respectable womanhood. In the darkened room, not only did women become the principal actors of the séance, they also transgressed gender norms, by assuming male roles or highly sexualised trance personae. The subversiveness of the movement alarmed and alerted the medical profession, which was in charge of policing any deviations from the social order imposed by Victorian patriarchy. The emerging medical branches of psychiatry and gynaecology effectively teamed up to prove that women’s health depended on female biology. Since women’s role was primarily that of generator, physical and intellectual activities would compromise the balance of nerve force necessary for the functioning of the reproductive organs, thus causing mental instability. Most cases of insanity due to sexual illness tended to result in monomanias, among which Spiritualism was counted, and doctors began to consider any kind of suspension of everyday consciousness suspicious and to associate mediumistic trance, with its uncontrollable convulsions and frequent use of inappropriate language, with the pathological symptoms of hysteria.

'Queer fancies'

In All in the Dark, Dinah Perfect is depicted as a strong-willed, authoritative, and eccentric woman. Her faithful servant explains that Dinah has always been very extravagant, with her odd dispositions concerning her corpse and coffin:

She was very particular, […] and would have her way; […] she had her coffin in the house this seven years – nigh eight a’most – upright in the little press by the left of the bed, in her room – the cupboard like in the wall. Dearie me! ’twas an odd fancy, […] and she’d dust it, and take it out, she would wi’ the door locked, her and me, once a month. She had a deal o’them queer fancies, she had. [II, pp.168-9]

'She is in a highly hysterical state'

It is no surprise, then, that when the novelty of table-rapping reaches the Old World, it appeals mightily to a housebound, bored, middle-class spinster like Dinah, who is looking for excitement and escapism from the monotony of everyday life, and from the increasing fear of ageing and dying. However, Dinah’s credulity is quickly associated with hysteria. Echoing Dr William Carpenter’s theory on unconscious cerebration, the non-believing, sceptical (and alcoholic) Dr Drake describes the dangerous effects that Spiritualism could have on Dinah’s mind, by convincing her of the reality of her delusions to the point that her body comes to provoke the effects that she expects to happen. Dr Drake is afraid that Dinah will ‘frighten herself out of her wits’, and explains to William that Spiritualism can affect the nerves [I, p. 60]:

Why, you know what hysteria is. Well, she is in a highly hysterical state. She’s a woman who resists; it would be safer, you see, if she gave way and cried a bit now and then, when nature prompts, but she won’t, except under awful high pressure, and then it might be serious; those things sometimes run oft’ into fits. [I, pp. 38-9]


Wrongful confinement


At a time when the advances in the realm of the mind became increasingly associated with scandals related to wrongful confinement, Le Fanu questions the power held by Victorian psychiatry over extravagant and independent women. Dinah Perfect is certainly a bizarre character, with her many fancies and her addiction to table-turning. However, her oddities do not seem sufficient to diagnose her as incipiently insane. Dinah is an elderly woman troubled by the frightening thought of upcoming death. Her anxiety and hysterical crises echo the spiritual uncertainty that afflicted the author’s sister and wife, like many other Victorians. Moreover, her uneasy shifting between her family’s orthodox Christianity and the occult is reminiscent of Le Fanu’s own crisis of faith, which led him to find comfort in the doctrine of the Scandinavian mystic Emanuel Swedenborg.

 Le Fanu's wife Susanna (née Bennett), and his sister Catherine. All three experienced a crisis of faith at some point in their lives. The images of Susanna and Catherine appear in W. J. McCormack’s biography of Le Fanu.

'That foolish spirit-rapping'

Having experienced first hand the anxiety of spiritual doubt, Le Fanu is far from labelling Dinah mad, even though he does not sympathise with Spiritualism. In fact, all throughout the novel, Dinah sounds reasonable and practical, advising her ward on the importance of a good match in marriage, and her nephew on the more advantageous prospect of the Church rather than the Bar as a profession. Even on spiritual matters, the Rector confirms that, ‘I found her views […] all very sound; indeed, if it had not been for that foolish spirit-rapping, which led her away – that is, confused her – I don’t think there was anything in her opinions to which exception could have been taken’ [II, pp. 171-2]. On all subjects but Spiritualism, Dinah is perfectly sound. However, her fancy for table-turning would, for orthodox Victorian psychiatry, be a strong enough proof of her insanity, as the real case of Louisa Nottidge had shown.

Louisa Nottidge

Like Dinah Perfect, Louisa Nottidge was a wealthy middle-aged spinster who had also spent money ‘very wildly’ upon the word of a Spiritualist [I, p. 8]. In 1846, Nottidge decided to leave her mother’s home to follow the influential millenarian prophet Henry Prince. Prince was the founder of a small community in Somerset called the Agapemone (the Abode of Love), where he taught about free love and preached of everlasting life to a group of devotees who had agreed to donate all their wealth to the congregation. Three of the five Nottidge sisters had already joined the prophet (who had thus gained some £18,000), so that when Louisa communicated her decision to her mother, the latter had to act quickly in order not to lose another daughter, and her considerable fortune, to an unscrupulous charlatan. Mrs Nottidge had Louisa abducted and confined to the majestic Moorcroft House private asylum at Hillingdon, in Middlesex, on the grounds of theomania. Louisa spent seventeen months at the Hillingdon, and was released only because the Commissioners in Lunacy were summoned upon concerns about her failing health. After her liberation, Louisa joined the millenarian community, transferred all her possessions to Henry Prince, and took legal action against her wrongful confinement.

A fraudulent committal

Moorcroft House private asylum at Hillington.
This picture is taken from Sarah Wise’s Inconvenient People.
The case was heard in court in 1849 before the Lord Chief Baron, the Right Hon. Sir Frederick Pollock, while the attention it received in the press provoked responses from alienists John Conolly and Forbes Benignus Winslow, and Lord Ashley, Chairman of the Commissioners in Lunacy. The Lord Chief Baron accepted Louisa Nottidge’s plea and ordered a compensation for the damages received. The suit made clear that Louisa’s admission to the Hillingdon had not been fraudulently obtained, since two doctors certified her insane on the grounds that she had ‘estranged herself from her mother’s house […] to follow a person of the name of Prince, whom she believed to be Almighty God, and herself immortal’. However, as Joshua John Schwieso has pointed out, although the two doctors had been summoned by the family physician on the basis of their ‘experience in cases of insanity’, their biographies suggest that neither of them was an expert in the field. Despite all this, the final verdict was reached because the Commission in Lunacy, in the person of Mr Mylne, failed to convince the Lord Chief Baron of the necessity of keeping Miss Nottidge confined, as shown in the following report which appeared in The Times in 1849:

The Lord Chief Baron: Mr Mylne, was this lady in such a state of mind as to be dangerous to herself or to others?   
Mr Mylne: Not so as I was aware of; not so far as I knew. 
The Lord Chief Baron: If she were not so, then how was it that you kept her in this asylum for seventeen months?
Mr Mylne: My lord, it was no part of my duty to keep her there. I was only to liberate her if I saw good and sufficient reason for adopting that course. 
The Lord Chief Baron: It is my opinion that you ought to liberate every person who is not dangerous to himself or to others. If the notion has got abroad that any person may be confined in a lunatic asylum or a madhouse who has any absurd or even mad opinion upon any religious subject, and is safe and harmless upon every other topic, I altogether and entirely differ with such an opinion; and I desire to impress that opinion with as much force as I can in the hearing of one of the commissioners. […]You say unsound mind, Mr Mylne. Had she any unsoundness of mind upon any other subject under heaven except as to entertaining these peculiar religious notions?
Mr Mylne: Miss Nottidge did not exhibit any symptoms of insanity of any other subject, my lord, that I observed.

Not only did the Lord Chief Baron support an individual’s freedom to hold religious opinions (as long as they remained harmless to both the person and other parties), he, most importantly, stated that he ‘very much doubted whether, if in this case the plaintiff had been a man, or living under the protection of a husband, the defendants would have dared to have taken the steps they had’.

An unwarranted influence

This case made evident how women, and particularly single women, were in danger of wrongful incarceration, since their unorthodox religious views (Louisa’s own mother affirmed that ‘she worships a false god’) could be easily exploited for financial gain.[ix] In fact, in the case of Louisa Nottidge, what her family were trying to save was the £5,728 7s 7d that she had bequeathed to the prophet. After her death in 1858, which occurred while she was still residing at the Agapemone, the Nottidges brought Henry Prince to court and succeeded in obtaining the return of Louisa’s property on the grounds of the prophet’s unwarranted influence upon the deceased. Thus, in the early 1860s, the case of Louisa Nottidge received new attention in the press, both in England and in Ireland, and was associated with the increasing number of cases of wrongful confinement which were causing much sensation, both in real life and in fiction.

Spiritualism and madness

In All in the Dark, Dinah, unlike Nottidge, is surrounded by relatives and friends who love her for who she is rather than for her fortune, and who will miss her dearly after her death. However, in discursively associating Spiritualism with madness, Le Fanu is reminding the reader of the existing danger that even an incompetent doctor like Drake, with no specific knowledge or experience of insanity, could actually provide enough evidence to have a woman like Dinah confined on the grounds of her unorthodox beliefs. Furthermore, he is also presenting a reflection on the double standard with which Victorian psychiatry was dealing with its patients. After Dinah dies, her sceptical nephew William also becomes ‘addicted to the supernatural’ and begins to believe that he is haunted by the spirit of his dead aunt [I, p. 58]. He suffers from nervous strain and hallucinations, and also admits that ‘I think I’m growing as mad as […] poor Aunt Dinah’ [I, p. 216, my italics]. However, no judgement is made about the possibility of his being a case of incipient insanity. William’s temporary condition is attributed to the weight of financial and sentimental concerns which, combined with the strong tea he likes to drink (a recurring theme in Le Fanu’s fiction), the heavy tobacco he likes to smoke, and the supernatural stories he likes to read, provokes nightmares and somnambulistic states. Financial problems, disappointment in love, bereavement, and hereditary disposition were all considered by Victorian psychiatry to be factors in the detection of mental insanity. The fact that such connections are ignored in William’s case seems to validate the words of the Lord Chief Baron, who doubted whether the same precautions would have been taken if the plaintiff had been a man.
In All in the Dark, Le Fanu touches on the topical association of alternative spiritualities with insanity. Drawing upon his personal experience as well as his professional familiarity, in his work for the national and international press, with contemporary debates on these topics, Le Fanu investigates the power game played by Victorian psychiatry over difficult citizens, women in particular. Although the novel shows Le Fanu’s contempt of Spiritualism, it nevertheless dismisses the accusations of madness levelled at the believer, thus becoming a warning to women readers.

Dr ValeriaCavalli recently completed a PhD in the School of English, Trinity College Dublin entitled 'They said she was mad: insanity in the fiction of Joseph Sheridan Le Fanu' (2014). She may be contacted at cavalliv "at" tcd "dot" ie. Details of an upcoming conference in Dublin on J.S. Le Fanu (15-16 October 2014) may be found here.

Further reading
  • J. S. Le Fanu, All in the Dark, 2 Vols (London: Richard Bentley, 1866), Vol. 2, pp. 168-9.
  • For a historical context on Spiritualism and Victorian medicine, see Alex Owen, The Darkened Room: Women, Power, and Spiritualism in Late Victorian England (Chicago, Ill.; London: University of Chicago Press, 2004), Ch. 6.
  • On Louisa Nottidge, see Sarah Wise, Inconvenient People; Lunacy, Liberty and the Mad-Doctors in Victorian England (London: The Bodley Head, 2012), Ch. 4; Owen, pp. 151-54; and Joshua John Schwieso, ‘‘Religious Fanaticism’ and Wrongful Confinement in Victorian England: the Affair of Louisa Nottidge’, Social History of Medicine (1996), pp. 159-74. 

Friday, 9 May 2014

‘Poisons or other Noxious Things’: Women’s Illegal Abortion Strategies in Twentieth-Century Ireland by Cara Delay

In this month's post, Professor Cara Delay, Associate Professor at the College of Charleston, writes on women's illegal abortion strategies in twentieth-century Ireland. 

Abortion trials in Ireland

From the murder trial of infamous midwife and abortionist Mamie Cadden in 1956 to the tragic death of Savita Halappanavar in 2012, no issue has caused as much scandal, debate, and controversy in Ireland as abortion. Given the difficulty of accessing historical abortion cases, it is not surprising that scholarly analyses of abortion in Irish history remain incomplete. Illegal abortion is still at times perceived by historians as gambles that women took at the spur of the moment. Some researchers have assumed that the very real threat of illness or death would make only the most desperate of women seek to end their pregnancies. Records at the National Archives of Ireland and the PRONI, however, which provide details on over 100 illegal abortion trials that took place in Ireland and Northern Ireland from 1900 to 1970, demonstrate a different reality: for Irish women, abortion was not something that they took lightly but part of a carefully thought out plan. Abortion trial records tell complex and complicated stories, and, when read closely, shed light on women’s reproductive experiences and their decision-making processes.
Liquid ergot. Image courtesy of the Wellcome Library.
Attempting to construct a picture of the ‘typical’ Irish woman who hoped to end her pregnancy is nearly impossible: the reality is that women from all different walks of life attempted abortion. Helen O, who died in 1956 after receiving an abortion from Mamie Cadden, was a thirty-four-year old married mother of six. Twenty-year-old Irene A, in contrast, was an unmarried student. Margaret M, a twenty-five-year-old single woman who lived in Dublin but received a surgical abortion in London, was having an affair with her married employer. In 1948, a woman who pled guilty to giving abortions to at least eight women in County Laois had amongst her clients a teenage girl still living with her parents and a married mother of two. The variety that these examples reveal suggests that abortion was widespread and practiced by women of different marital status, age, and region.
It is impossible to know how many Irish women with unwanted pregnancies sought abortion as a solution. Criminal court case transcripts do, however, reveal how some of those women who did choose a termination proceeded. In almost all of the cases that ended up in the criminal courts, a woman with an unwanted pregnancy first attempted a self-induced miscarriage. These women acted to induce abortion through what are often called ‘folk methods’, including physical harm and hot baths. Women, then, attempted to take care of what they referred to as their ‘trouble’ themselves in private, or sometimes with the help of friends and family. As late as 1950, a Dublin woman named Sheila told the court that before she purchased abortion drugs, she tried gin and hot baths, and when that did not work, her lover told her to ‘try high jumps’.

If these physical harm methods didn’t work, women sought help from drugs and poisons, including both readily available items such as Epsom salts, Jeyes’ Fluid, and laxatives and traditional abortifacients, including quinine, pennyroyal, and ergot of rye. Helen O, who died at the hands of Mamie Cadden, tried quinine tablets before she sought a surgical abortion. Similarly, in a 1937 case, a woman unsuccessfully tried miscarriage by quinine pills before visiting abortionist William Coleman. In 1932, a Donegal woman was brought up on charges after she attempted miscarriage by taking ‘six pills, the nature of which is unknown, two Beecham’s pills, and a bottle of castor oil’.

Source: Leitrim Observer, 1 December 1917
The poisoning deaths of women who consumed too many abortifacients remind us that self-induced abortion was hardly a science. Although Irish women were aware of the dangers of consuming too much of a particular drug, they persisted in attempting self-abortions, and they were given hints about drug-induced miscarriages through advertisements. Despite the fact that Ireland’s 1927 Report of the Committee on Evil Literature sought to prohibit any advertisements for drugs that may be used to prevent conception or induce miscarriage, Irish newspapers and medical publications contained dozens of such ads. In the early twentieth centuries, newspapers such as the Irish Times and the Leitrim Observer featured advertisements of Widow Welch’s Pills and Towle’s Pills, which eventually would become evidence in several abortion trials. Dr. Hooper’s Female Pills, created in Britain 1743, were advertised nearly every month in the Irish Chemist and Druggist in the late 1920s and 1930s. Another example is Beecham’s Pills, a British product available in Ireland that featured in several abortion trial cases. Beecham’s Pills were billed as a cure-all for lots of things, including restoring normal menstruation. Female pills contained a variety of substances, some potentially effective and some not. Dr. Hooper’s Pills were made of myrrh, which was rumoured to be an abortifacient. Some emmenagogues, including Towle’s Pills, did contain pennyroyal, which may have effectively induced miscarriage.


One of the most striking realities of abortion in twentieth-century Ireland is how many women attempted abortion multiple times. One woman received abortions from Laois’s Kathleen G twice, once for an advanced pregnancy of eight months and once for an early pregnancy of two months. Others admitted in court that they had previously attempted abortion, sometimes successfully and sometimes not. These repeated attempts to cause abortion reveal that determination defined the attitudes of some women. Women for whom abortifacients were unsuccessful or who initially were turned away by doctors or others did not stop looking for someone to help them. In one case, a couple traveled to London for an abortion after an Irish doctor refused to perform one. Other women traveled from the countryside to Dublin, where it was apparently easy to find an abortion practitioner. The Irish Times, reporting on a 1944 abortion case, recorded the remark of the defense lawyer in the case as follows: ‘Dublin was always humming and buzzing with stories about abortion’. Some of the most notorious Dublin abortionists, including not only Mamie Cadden but also William Coleman, faced multiple prosecutions over the years, demonstrating the continued need for and popularity of their services.

Illegal abortion on Irish soil declined rapidly with the 1967 legalization of abortion in the UK (outside of Northern Ireland), combined with relatively easy and inexpensive travel methods that allowed Irish women to seek assistance in Britain. Recently, however, the availability of herbs and pills on the internet has resulted in a return to more traditional abortion practices: more and more women are, once more, turning to abortifacients and home-based, self-induced abortions. In 2009, the Irish Medicines Board confiscated over 1,200 abortion pills that were bought online and imported into Ireland. Abortion rights organization Choice Ireland has argued that there is now an abortion pill black market in Ireland that is thriving during the economic crisis, when it is more feasible for women to purchase pills than travel to Britain for a surgical abortion.

Even a cursory glance at available evidence proves that Ireland is a country with a deep and varied historical record of backstreet abortion. The secret journeys of women who travel abroad for a legal termination every day or who purchase drugs illegally on the internet are legacies of the past in a country that still has a long way to go to recognize the reality of abortion.

Professor Cara Delay is Associate Professor at the College of Charleston. She was a Fulbright Fellow at the Humanities Institute, University College Dublin (2012-2013) where she conducted research on her new project entitled 'Desolate Journeys: Reproduction and Motherhood in Ireland, 1950-2000'. A podcast of her recent paper at the CHOMI Seminar Series on illegal abortion cases in twentieth-century Ireland may be accessed here


Podcast of a lecture 'Noxious Things’: Illegal Abortion Cases in Twentieth-Century Ireland by Professor Cara Delay, given as part of the UCD Centre for the History of Medicine in Ireland’s seminar series.

Friday, 11 April 2014

Treating Measles in late Seventeenth-Century London and Dublin by Elizabethanne Boran

This month, Elizabethanne Boran, librarian at the Edward Worth Library, Dublin, writes on treating measles in late seventeenth-century London and Dublin, with particular focus on the works of John Pechey (1654-1718), many of which were collected by the Irish physician Edward Worth (1678-1733). 

A keen collector of medical works

Title page of  John Pechey's Collections of Acute Diseases (1691)
‘These Measles began very early, as they use to do, to wit, at the beginning of January, 1670/1 and increasing daily, came to their height at the Vernal Æquinox, i.e. the Tenth of March: afterwards they gradually decreas’d. and were totally extinguish’d the following July’. Thus begins John Pechey’s account of an outbreak of measles in his Collection of Acute Diseases (London, 1691), a book collected by the early eighteenth-century Dublin physician, Edward Worth (1676-1733). Worth was a keen collector of all kinds of medical and scientific works and was particularly interested in infectious diseases. As the Worth Library’s online exhibition on infectious diseases demonstrates, his main areas of concern were plague, smallpox, syphilis, and tuberculosis, not to mention all kinds of fevers, but he was also avidly interested in books on other infectious (and non-infectious) diseases.

John Pechey

Perhaps it was for this reason that Worth was drawn to the works of John Pechey (1654-1718), for he collected no less than seven books by this popular author: Pechey’s Collection of Acute Diseases (London, 1691) had quickly been followed by his Collections of Chronical Diseases (London, 1692). Three years later Pechey’s Storehouse of physical practice was on the market and in the next two years he produced a book a year: Treatise of Women’s Diseases (London, 1696) and Treatise of Children’s Diseases (London, 1697). All of these books were collected by Edward Worth who joined to them a 1700 edition of Pechey’s Promptuarium praxeos medicae (which had been a Latin translation of the Storehouse), and, finally, in 1707, Pechey’s Compleat Herbal of Physical Plants. Though these books didn’t not represent the entire output of Pechey (which includes a host of pamphlets on the virtues of his famous medical concoctions), it is clear that Worth was drawn to Pechey’s understanding of disease, which was, in turn, heavily dependent on the works of the great English physician, Thomas Sydenham (1624-1689), whose works were translated and published by Pechey.

Portrait of Thomas Sydenham

A fractious relationsip with medical authorities

Pechey was the son of William Pechey, a Sussex ‘Practitioner in Physick and Surgery’, whose influence his son publicly acknowledged in the fifth part of his Collection of Acute Diseases. Judging by this dedication, Pechey had a fractious relationship with medical authorities. Initially his education had been unremarkable: he had taken a BA and MA from the University of Oxford in 1675 and 1678 respectively and in late 1684 he had successfully taken the Royal College of Physicians licentiate examination. Three years later he, and a number of other licentiates, set up practice at the Golden Angel and Crown in King’s Street, London and it was there his trouble started. His and his colleagues’ decision to advertise their medical services with the admirable promise that ‘the sick may have advice for nothing’ was met with less than enthusiasm by the medical authorities, who were appalled at Pechey’s approach. Legal battles ensued and it was in this context that Pechey issued the first edition of his Collections of Acute Diseases, which was published in London in 1686. In effect, Pechey had simply translated Thomas Sydenham’s works on smallpox and measles into English, no doubt in an effort to demonstrate how mainstream his medical teaching was. This was by no means plariarism: Pechey undoubtedly had the support of Sydenham in translating his work and he was himself keen to give credit where credit was due. Indeed he informs the reader that he had ‘chiefly collected from Dr Sydenham, because I have found by Experience, that his Methods in Acute Diseases have been most successful in practice. The Chapter of a Peripneumony was taken from Willis. The Chapter of Women’s Diseases, from Riverius and from Mauriceau, The Chapter of an Apoplexy, Lethardy, Coma and Carus; likewise from Riverius.’ It is revealing that works by all these authors were likewise collected by Worth.

The 'English Hippocrates'

The choice of Sydenham was a shrewd one – as the numerous editions of Pechey’s English translation of Sydenham’s complete works testify. But if Pechey hoped to win approval by translating Sydenham’s works his hopes were dashed for Sydenham’s own relationship with the Royal College of Physicians was problematic. It is at first sight surprising that so eminent a physician, one who was regarded as the ‘English Hippocrates’ due to his emphasis on clinical experience, was never made a Fellow of the College. However, it was precisely Sydenham’s advocacy of experience over theoretical medicine that threatened the status of the members of the College. Sydenham might have avoided publishing his most radical attacks on the medical establishment but there was sufficient criticism of them in his famous Methodus to ensure that they were less than attracted to the likely social implications of his health regime.

Bleeding a patient

'These Men blame me for Englishing their Mysteries'

 So Pechey’s advocacy of Sydenham, though it fitted in perfectly with his own medical philosophy, was unlikely to endear him to the Royal College of Physicians who were already incensed by Pechey’s propensity for advertising his medical wares. Not only this, but, as Pechey explains to the reader in Worth’s 1691 edition of the Collection of Acute Diseases, the very method of his popularizing of Sydenham was criticised: ‘These Men blame me for Englishing their Mysteries, though they know that Hippocrates and Galen and Celsus, and many others wrote in their Mother-Tongue.’ That didn’t stop him for, as his preface to his father makes clear, his publications represented not only an opportunity for financial gain but more importantly were part of a crusade to defend the importance of practice and experience over theory, and, at the same time, to democratize medical knowledge by making the works of eminent doctors available in English to non medical readers. In this Pechey seems to have been following his medical hero, Sydenham, for the latter never joined the ranks of fashionable doctors and was more than happy to treat poor patients.


Therefore, much of Pechey’s description and suggestions for treating measles comes directly from Thomas Sydenham. Certainly both men would have concurred that ‘the Patient be kept in his bed onely two or three days after the eruption, that the bloud may gently breath out, according to its own genius, through the pores of the skin, the inflam’d Particles that are easily separable which offend her; and that he have no more cloaths nor fire, than he is wont to have when he is well’. Though Sydenham in general opposed the treatment of bleeding in cases of fever and smallpox, he admitted that in some cases of measles the standard practice of bleeding should be implemented. Edward Worth’s collection of medical books demonstrate that this early eighteenth-century Dublin physician was a keen follower of the Pechey-Sydenham approach to infectious disease.
Elizabethanne Boran is librarian at the Edward Worth Library, Dublin. She may be contacted at elizabethanne "dot" boran "at" hse "dot" ie.

Thursday, 13 March 2014

The Crusade to ‘Conquer Cancer’ in Ireland, 1950s-70s - Smoking and Lung Cancer: The Rise of the Visual by Jane Hand

In this month's blog post, Jane Hand, a PhD student at the Centre for the History of Medicine, University of Warwick, writes about public health initiatives in the campaign against lung cancer in Ireland, c.1958-78. This was the subject of her MA dissertation undertaken at CHOMI, UCD (2011).

Since the late 1950s the relationship between smoking and lung cancer gained increased national prominence in Ireland, becoming the focus for a variety of both public and voluntary health education campaigns. The visual component of these health campaigns was central to the formulation of health education strategies reflecting changing perceptions of disease. In addition, as health advertising became increasingly central to public health, aspects of medicine and media consumption became more closely allied. This facilitated the emergence of a lifestyle-orientated public health centred on behavioural modification in relation to chronic disease diminution.

Fig. 1 Anti-Smoking Leaflet aimed at children, 
Department of Health and Children (NAI S16659A)
The causal connection between smoking and lung cancer was the first major chronic disease model to be explicitly linked to lifestyle factors. Consequently, health education material attempted to incorporate models of behavioural change. The initial release of anti-smoking publicity material in 1958 consisted of two leaflets highlighting the connection between smoking and lung cancer. As shown in Fig. 1 and Fig. 2, the first leaflet targeted adults, whilst the second aimed at reducing the smoking uptake amongst the young. Both publications employed visual techniques centred upon simplistic imagery, eye-catching colour usage and the juxtaposition of upper and lower case text to emphasise particular aspects of its composition to the reader. By adopting a question/answer format these leaflets provided concise and precise health information whilst removing medical jargon from their explanatory texts. Their basic function was to establish a specific mode of behaviour and correct health conduct in relation to cigarette smoking. Minister for Health, Séan MacEntee made the rationale behind the publication of these leaflets by the Department of Health exceedingly clear: ‘The reports of investigations into the death rates from lung cancer have ensured that the results must be brought to the notice of the public’.1
Fig. 2 Anti-Smoking Leaflet aimed at adults,
Department of Health and Children (NAI S16659A)
Efforts to reduce tobacco consumption amongst younger age groups remained a central objective of state-led health promotion initiatives. Consequently the “Smoking Kills Your Taste for Life” campaign centred upon the mantra ‘If You Don’t Smoke - Don’t Start, If You Do Smoke – Stop Now!’ which represented the principal component of the Department’s health education strategy for much of the 1970s. A series of health educational films, including the “Smoking Kills Your Taste for Life” filmlets, were shown in primary schools throughout the country, with Irish-language voiceovers for those schools situated in Gaeltacht areas and some others that requested the Irish version.2

The dangers of smoking were compiled in a booklet The Facts about Smoking and Health, anti-smoking posters were widely circulated and a series of shorts were aired on RTÉ television.3 The establishment of a poster competition on a non-smoking theme proved particularly popular.4 The competition itself was widely advertised using press, radio and television. Entry forms had themselves acted as advertisements, comprising a strong anti-smoking message. As displayed in Fig. 3, these provided educative information concerning the dangers of smoking whilst appealing to the public-consciousness to elicit a positive response: ‘Deep down you must know that smoking is bad for your health – but let’s face it, at your age lung cancer seems a remote possibility’.5  The use of a direct-address style in the accompanying text to this pamphlet only served to further foster a perception that confidence in curative measures was maintained within the visual expression of disease and illness.

Fig. 3 ‘Smoking Kills Your Taste for Life’ poster competition entry form
Department of Health Files (INACT 428227)

During the 1970s an emphasis on the harmful effects of tobacco smoking on the lungs became more overt. The utilisation of various shock tactics, specific medical knowledge and biological explanations became increasingly standard practice. Science was becoming as much a part of the various promotion techniques employed, as were those pleas to health consciousness. Increased biological knowledge facilitated the emergence of a series of intellectually founded anti-tobacco smoking campaigns, particularly those instigated by the Irish Cancer Society, such as “How Smoking Affects Us” reproduced as Fig. 4.6 The caption serves to draw the reader’s attention to the integral message of the leaflet thus preventing any possible misinterpretation.7 By combining text and illustration the pamphlet successfully attempts to heighten its educative purpose. Ultimately the use of a diagram coupled with numbered explanations serves to convey an otherwise complicated medical message in a concise and understandable format.
Fig. 4 Anti-Smoking Leaflet produced by the Irish Cancer Society,
Department of Health Files (INACT 
The 1970s represented the era when persuasion media as a method of health education became central to public health campaigns. Analogous to Britain, state expenditure on health promotion increased dramatically reaching £110,000 for the year 1970-1971, thereby facilitating the application of new-style advertising campaigns highlighting the tobacco and lung cancer risk.8 Campaigns developed a more scientific and biological character. The use of a series of precise anatomical diagrams designed to outline the effects of smoking on the body became evermore commonplace Whereas almost all anti-smoking propaganda produced during the late 1950s and 1960s had focused exclusively on the relationship between smoking and lung cancer, the 1970s was notable for widening the scope of the anti-smoking crusade. No longer was the lung perceived as the only body organ to be affected by the adverse effects of prolonged cigarette smoking, but rather its additional detrimental effects, as displayed in Fig. 5, Fig. 6 and Fig. 7, on the heart, brain, and nose and throat in particular were increasingly expounded.
Fig. 5, Fig. 6 and Fig. 7 The Better Health Pack Leaflets
on the bodily effects of smoking (NLI Ir614 h4)
Moreover, the focus altered somewhat with increased state interest in the effects of smoking on the pregnant woman. The dangers of smoking in pregnancy were highlighted in a special article entitled ‘You and Your Baby’ which was distributed nationally by the medical profession to expectant mothers.9 With the formation of the Health Education Bureau in 1975 and its greatly increased budget following the appointment of Charles Haughey as Minister for Health in 1977, state sponsored health campaigns adopted a more sophisticated composition.10 The tar and nicotine content of cigarettes was increasingly emphasised to create an anti-aesthetic surrounding the habit of smoking.11 The promotion of anti-smoking material centred on the endorsement of behavioural change rather than on compulsion, with the media providing the key factor within a new style of health activism. 

The modification of individual behaviour through the initiation of highly stylised visual health campaigns became central to public and voluntary information programmes. As encapsulated by MacEntee, lifestyle choice and behavioural change became pivotal to the success of anti-smoking education campaigns centred upon the concept that ‘If you have never smoked, don’t take it up; if you are already a smoker, give it up, or at least do not smoke immoderately’.12 By accepting the epidemiological argument for a connection between smoking and lung cancer both the state and voluntary organisations alike firmly aligned themselves to the implementation of a programme of preventative measures. This was achieved through the adoption of visual illustration as the main feature of health advertisement material. The promotion of anti-smoking material within Irish public health campaigns relied upon the efficacy of visual advertising in producing health responses on the part of the public. Ultimately this ‘visuality’ in promotion methods was key to the rise of a new health ideology based on individual responsibility for healthy lifestyles and behaviours.

Jane Hand is a doctoral student at the Centre for the History of Medicine, University of Warwick. Her PhD is entitled 'You Are What You Eat: Chronic Disease, Consumerism and Health Education in Britain since the Second World War' and she may be contacted at j "dot" hand "at" warwick "dot" ac "dot" uk

Author’s note:
The images reproduced in this post were sourced directly from the Department of Health with the permission of Fergal Flynn, Department of Health.
All other primary source material is held at the National Archives of Ireland.

1. Department of An Taoiseach, ‘Cancer: Publicity Leaflets etc.,’ 11th February 1958, National Archives of Ireland, TAOIS S16659A. [Italics added by author].
2. Anon, ‘Radio programme on cigarette smoking’, 1973, Department of Health and Children, INACT 461262.
3. Minister for Health (Erskine Hamilton Childers), ‘Radio Programme on Cigarette Smoking 19/06/1973 – Written Answers’, Department of Health and Children, INACT 461262.
4. Minister for Health (Erskine Hamilton Childers), ‘Radio Programme on Cigarette Smoking 19/06/1973 – Written Answers’, Department of Health and Children, INACT 461262.
5. Minister for Health (Erskine Hamilton Childers), 'Address by Mr Erskine Childers, T.D., Táinaiste and Minister for Health at the Prize-giving ceremony in the anti-smoking poster competition in the Metropole Ballroom, Dublin, 6 January, 1971’, Anti Smoking Poster Campaign for School Children and Television Campaign, Department of Health and Children, INACT 422036.
6. The Information Services of the Irish Cancer Society, Smoking Burns You Up: How Smoking Affects Us, Leaflet Department of Health and Children, INACT 428227.
7. Cooter and Stein, ‘Coming into focus’, p. 186.
8. Coiste no gConnartha Rialtas, ‘A meeting of the Government Contracts Committee’, 6 August 1970, Department of Health and Children, INACT 422036; Minster for Health (Erskine Hamilton Childers), ‘Ceisteanna – Questions. Oral Answers – Health Educational Programmes’, Dáil Debates, vol. 254, col. 2249-2250, 23 June 1971; Berridge and Loughlin, ‘Smoking and the New Health Education in Britain 1950s-1970s’, pp 960-961.
9. Anon, ‘Radio programme on cigarette smoking’, 1973, Department of Health and Children, INACT 461262; ‘ “You and Your Baby”: A Family Doctor Publication by the Irish Medical Association in conjunction with the British Medical Association’, Department of Health and Children, INACT 461262.
10. Dwyer, Short Fellow, p. 152. 
11. Berridge and Loughlin, ‘Smoking and the New Health Education in Britain 1950s-1970s’, p. 961.
12. Irish Times, 5 Dec. 1959.